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7 Medications That Can Cause Dry Eyes

Health A-Z

Dry eye is a condition in which inadequate tear production leads to eyes that burn, sting, or feel gritty, among other symptoms. While there are multiple causes, one to consider is medication. A surprising number of over-the-counter and prescription meds can cause dry eye.

Antihistamines

Antihistamines provide much-needed relief of allergy and cold symptoms, including sneezing, itching, watery eyes, and a runny nose. This category includes over-the-counter medicines like Allegra (fexofenadine), Claritin (loratadine), Zyrtec (Cetirizine) and Benadryl (diphenhydramine). Unfortunately, these drugs also do a number on your eyes, reducing the watery tear film that keeps them moist. Antihistamines block the effect of the chemical histamine, which the body produces in its attack against allergens

The fact that dry eye can produce symptoms similar to an allergy can be confusing.

“If you have a scratchy, gravelly graininess, that’s lack of watery tear,” explained Steven Maskin, M.D., medical director of the Dry Eye and Cornea Treatment Center in Tampa, Fla. “Then ask yourself, did I just take a Benadryl the other day or an allergy medication because I started sneezing? That can dry you out,” he said.

Nasal decongestants

What’s soothing to a stuffy nose may not be so gentle on the eyes. Over-the-counter decongestants are the go-to medicines for easing cold and flu symptoms, hay fever and sinusitis. They work by narrowing blood vessels in the membranes of the nose. Blood flow to swollen nose tissue is reduced, allowing blocked-up noses to breathe with greater ease. Nasal decongestants come as pills, liquids and nasal sprays. They’re sold under a slew of brand names containing ingredients like phenylephrine, pseudoephedrine and oxymetazoline. But like antihistamines, they decrease tear production. Some products on the drugstore shelves combine an antihistamine and a decongestant—a double whammy on the eyes.

Blood pressure-lowering drugs

People who take prescription medications to lower their blood pressure and treat certain heart conditions, can also suffer from dry eye. Beta blockers, for example, slow heart rate, reduce the force of heart muscle contractions and lessen blood vessel contraction. But these drugs are thought to decrease sensitivity of the cornea, the transparent window of the eye. When that happens, it can dampen the stimulus for tear glands to release tears, Dr. Maskin explained. Diuretics, also known as water pills, are another type of blood pressure-lowering medicine that work by encouraging the body to excrete more urine. Drugs like Microzide (hydrochlorothiazide) and Lasix (furosemide) flush excess water out of the body—and the eyes.

Antidepressant, psychosis, and Parkinson’s medications

Elavil (amitriptyline), a tricyclic antidepressant, and thioridazine for schizophrenia are among a group of medicines with so-called anticholinergic effects. They block the transmission of nerve impulses.

Normally, a healthy nerve sensing eye dryness would send a signal that gets passed along until it reaches its destination and tears are released. But when that communication network breaks down, the message becomes undeliverable. And that’s what leads to dry eye, Dr. Maskin explained.

Artane (trihexyphenidyl), used to combat stiffness, tremors and spasms in Parkinson’s disease, has the same anticholinergic properties.

Popular medicines like Zoloft (sertraline) and Paxil (paroxetine) belong to a different class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs). But they, too, can cause dry eye.

Hormone replacement and oral contraceptives

Women who take hormone replacement, particularly estrogen alone, have a greater likelihood of developing dry eye. In a study involving more than 25,000 post-menopausal women, researchers showed a 69% increased risk of dry eye compared with a control group. Those taking estrogen plus progesterone had a 29% greater risk of dry eye than women not taking hormones.

Women are also more likely to develop dry eye due to hormonal changes linked to the use of birth control pills.

The exact relationship is between hormones and eye dryness is unclear, Dr. Maskin said. It could be that estrogens alone adversely affect the oil-producing glands of the eye. Estrogen may also reduce the so-called aqueous, or water, layer of the tear film, he added.

Acne medicine

Dermatologists sometimes prescribe isotretinoin for severe, scarring acne or acne that doesn’t respond to other treatments. This powerful drug, once sold under the brand name Accutane, has a drying effect on oil glands. It’s known to cause irritation of the eyes and eyelids, among other common side effects.

“It decreases overall mucus production and secretion,” said Stephanie Crist, Pharm.D., an assistant professor of pharmacy practice at St. Louis College of Pharmacy in Missouri.

Accutane’s checkered history includes a link to birth defects, depression, suicidal thoughts and bowel disorders. Although drugmaker Roche Pharmaceuticals pulled it from the market in 2009, generic versions are still available.

Eyedrops

“Avoid the drops that ‘get the red out,’” Dr. Maskin cautioned. Visine (tetrahydrozoline ophthalmic), for one, works by narrowing blood vessels to the eyes to reduce redness. But when the drops wear off, the vessels can become larger and more inflamed.

“The key is to find out what’s causing the redness, not to try to hide the redness,” he said.

Allergy eyedrops are another potential hazard. Yes, they can relieve itchiness due to allergy symptoms. But what if your eyes are itchy because they’re dry? Now you’ve made the problem worse, because antihistamines in allergy drops decrease tear production, making your eyes even more dry and itchy.